Californians May Now Opt for “Death with Dignity”

Credit: yourlegacylives.com

On June 9, 2016, California will become the fourth state in the United States to enact legislation that allows physicians to aid terminally ill patients in ending their lives. The legislation, known as the End of Life Option Act, was signed by Gov. Jerry Brown on Oct. 5, 2015.

Modeled after “death with dignity” laws in Oregon and Washington, the California statute sets forth a number of criteria that define which patients are eligible to receive aid in dying. For example, two physicians must certify that the person has six months or less to live and is mentally competent to make the decision to end their lives. A psychiatric examination is not required, but physicians have the option of requesting one if they believe a patient is clinically depressed or otherwise incompetent to make decisions on their own behalf.

Additionally, patients must go through a lengthy process before actually receiving a prescription for a lethal dose of a drug. First, they must ask their physician to provide aid in dying on two separate occasions at least 15 days apart. They are also required to submit a formal request in writing that must be signed by two witnesses who attest that the request is being made voluntarily.

In Oregon, nearly 86 percent of patients who chose physician assisted death had cancer
(Credit: hubpages.com)

The patient’s attending physician then fills out a form stating that he has advised the patient of alternatives to ending his life, including hospice, palliative care and medication to control physical pain. He must also refer the patient to a consulting physician who attests to the patient’s diagnosis and prognosis and affirms that the request is being made voluntarily.

The law is silent on a number of issues, including which medication should be used. In Oregon, where death with dignity legislation has been in place for nearly 20 years, the most commonly prescribed aid-in-dying drug is secobarbital, a barbiturate.

Sponsored by the group Compassion & Choices, the End of Life Option Act faced stiff opposition from the disability advocacy group Californians Against Assisted Suicide, which believes that aid-in-dying laws place “explicit and implicit pressure” on vulnerable populations to end their lives. A number of physician groups also expressed opposition, including the Medical Oncologist Association of Southern California. “We think that people who are properly taken care of don’t need to end their own lives,” said oncologist Michael J. Schlutz, M.D., in a statement to the L.A. Times. 

Physician attitudes notwithstanding, data from Oregon indicates that most patients who choose physician assisted death do so for reasons other than physical pain. In fact, fewer than 10 percent of terminally ill patients in the state who chose to end their lives between 1998 and 2014 did so because of “inadequate pain control” or concern about physical pain. Rather, 75 percent said that either loss of autonomy or loss of the ability to engage in activities they enjoyed was the reason they chose physician assisted death.